Study Explores Why Female Surgeons Perform Fewer Complex Procedures Than Males

Researchers at Massachusetts General Hospital (MGH) have found that female surgeons are more likely to perform easier procedures than their male peers. 

The study, which was published in Annals of Surgery earlier this month, analyzed 551,047 case records of surgeries performed by 131 surgeons at MGH from 1997 to 2018. Researchers found that the procedures female surgeons performed were 23% less complex than those performed by men. 

The study is the first of its kind to look specifically at underemployment among female surgeons over an extended period of time.

Researchers also discovered that mid-career surgeons were more likely to experience underemployment, and that the problem did not improve over the 20-year period being studied. This suggests that the bias towards women is systemic, and that the current method in place for helping female surgeons advance professionally isn’t working. 

How the Medical World Views Female Surgeons

“During residency, it’s very common for female residents to be perceived as nurses, not physicians,” David Chang, PhD, MPH, MBA, an associate professor of surgery at Harvard Medical School and co-author of the study, tells Verywell. 

While the number of female doctors has increased substantially in the last few decades, women are still severely underrepresented in surgery, making up less than 25% of ten surgical specialties, the only exception being obstetrics and gynecology, where women represent 57%. For those who do make it into the surgical field, this recent study suggests there are still obstacles. 

“Even though you get to become a surgeon, you are not offered the same opportunities or treated equally,” Ya-Wen Chen, MD, MPH, the lead author of the study, tells Verywell.

What This Study Reveals That Others Don’t

This study is the first of its kind to really compare the kind of work male and female surgeons do. Cassandra Kelleher, MD, a pediatric surgeon at MGH and senior author of the study, tells Verywell that previous studies have measured outcomes like the number of promotions and NIH grants female surgeons receive, but these metrics are dependent on many factors and cannot be used as sole indicators of professional success. 

Surgeons usually undergo five years of surgical residency, plus an additional year or two to train in a subspecialty, to be able to perform complex, technical procedures. But often, Kelleher says, female surgeons are underemployed, meaning they are assigned procedures that are far less complicated, and that require less time caring for and interacting with patients.  

“A woman [surgeon] might do a hundred appendectomies, while the male surgeon next door will be doing complex bowel surgery,” says Kelleher says. The former is a routine procedure that, while important, takes around 30 minutes and requires little interaction with the patient afterwards. The latter is a procedure that is not only more technically challenging, but it also requires longer patient care after the surgery. Kelleher says doctors involved in more complicated procedures may interact with the same patients for years at a time.

“An appendectomy is something you learn in your first year of residency,” she adds for context. "It’s one of the first surgical procedures doctors are taught during their surgical training." For Kelleher, her experience has been that female surgeons often take on the bulk of shorter cases like appendectomies, which offer fewer opportunities to be challenged professionally. 

“It’s the surgical level of working for Starbucks as a college graduate,” Kelleher says.

Implications for Surgeons and Patients Alike

Typically, female surgeons rise in the ranks through extensive professional development and extra commitments. For Stephanie Bonne, MD, a trauma surgeon and assistant professor of surgery at Rutgers New Jersey Medical School, professional development has been pivotal to her career, but she feels like it’s something men do not have to do to risk in the ranks. 

“We’re still in a place where women have to be trained to be leaders,” she tells Verywell, whereas men advance in their medical careers without investing as much time in professional development opportunities. “We have to do all this extra work, which demonstrates bias.”

The study suggests that the extra work isn’t always paying off, with results showing that mid-career surgeons, precisely the ones who tend to seek out these extra opportunities for professional development, were among the most underemployed. Many women become frustrated and leave the profession entirely. 

“It’s not a question of ‘my feelings were hurt by my male colleagues’,” Kelleher says. “We’re driving women out of the workforce.” 

Chen suggests that the research has implications for patients. In a scenario where a cancer patient might want a female surgeon to perform a complex procedure on them, they might have to be passed over for a male doctor.

“Why should there be a difference in complexity based on your gender? It’s unfair for patients,” Chen says. 

The researchers are hopeful that this study will open up new doors to address systemic bias in the medical profession. In an ideal world, Kelleher says, you wouldn’t be able to differentiate a woman’s experience as a doctor from a male’s. 

“You could look through practice, promotions, pay, and satisfaction and you wouldn't be able to distinguish who was a man and who was a woman by doing that," she says.